Neurosyphilis yesterday and today

Ten years ago it might have been predicted that neurosyphilis would disappear, but this has not happened. It has altered in character so that almost all of the cases seen are meningovascular in type. Even with the acceleration of neurosyphilis that occurs with immunodeficiency it is unlikely that there will be a resurgence of tabes dorsalis, general paralysis of the insane (GPI) or gummatous involvement of the central nervous system. These entities are still reported as single cases in the literature and this is unlikely to change. Diagnostic vigilance is required in respect of meningovascular syphilis which presents in so many different guises, and it seems prudent to advocate that all patients admitted to hospital with a neurological or psychiatric disorder should have syphilis serology checked routinely, though it no longer seems necessary to perform the tests routinely on outpatients. Advances in serological testing have made the diagnosis of syphilis easier to establish, and further advances in the diagnosis of neurosyphilis are likely with the perfection of techniques to culture treponemes in the cerebrospinal fluid (CSF) or the detection of surface antigens in the CSF. Although syphilis remains a treatable disease the impact of AIDS has necessitated modifications to the treatment regime. It is now recommended that patients who are HIV-positive and who have early syphilis should be treated as for neurosyphilis, as the former regime for treating primary syphilis may not be adequate.